The managed care plan (MCP) is a type of healthcare insurance which is designed to deliver medical services to its clients at a lower cost. The providers of managed care solutions analyze the market, comparing the rates charged by different physicians, hospitals, and clinics, and then sign contracts with the ones who offer the lowest prices. They can successfully negotiate with the healthcare providers and obtain considerable discounts since these organizations have a large number of clients. These companies build large networks which include various hospitals and doctors and pay them an annual fixed fee. It is different from another insurance model, fee-for-service, which implies that the healthcare providers are paid for each of their consultations separately. Despite its major advantage of affordability, managed care plans are often criticized by the public for their limitations concerning the choice of physicians and the lack of insurance coverage for the out-of-the-network cases.
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One of the primary reasons why Americans oppose the MCP model is because they believe it to be aimed strictly at the reduction of costs. For example, managed care plans imply that a client will be able to consult only one physician who is a part of the insurance provider’s network (Pinkovskiy, 2020). Many perceive such a situation as a desire of the managed care organizations (MCOs) to make their customers overpay for healthcare services. Moreover, the cost restrictions of the MCP solution mean that some vulnerable groups will not receive proper care. People who are constantly in need of assistance with their daily activities such as dressing, feeding, and bathing may not be eligible for these services under their managed care plan (Jones, 2018). Thus, the limited number of opportunities is the main cause of the public’s backlash against the MCP model.
These are not the only problems which accompany the insurance option in question and are often reported by the clients. According to one study, MCP clients reported that they consistently experienced disorganization in the administrative processes, issues concerning communication with the MCOs, and declines in the provision of certain services (Arora et al., 2020). It demonstrates that there are significant challenges which the managed care providers have to address to improve their quality of operations. Apart from being unable to choose different physicians, individuals may not receive full insurance coverage for the services of a medical specialist who is not a part of the network (Duijmelinck & van de Ven, 2016). This creates a situation when a person, despite having an MCP, is forced to pay for themselves. Therefore, many people decide not to use a managed care plan, choosing other options, or avoiding being insured.
The MCP presents an affordable insurance solution, yet due to its strict limitations and certain problems, it frequently becomes a target of criticism. The general public often opposes this type of insurance, saying that its primary goal is to decrease the price of healthcare by depriving the clients of the right to choose their doctors. Other problems reported by clients of this insurance solution concern communication with the plan providers, organizational issues with the administrative activity, and the lack of coverage for people with special needs. Also, if an individual decides to visit a doctor who does not have a contract with the insurance provider, they may incur all the costs of the specialist’s services. Thus, the MCP model can be suitable for those who do not have serious health-related conditions and do not want to spend a large sum of money on insurance.
Arora, K., Rochford, H., Todd, K., & Kaskie, B. (2020). What can Europe learn from the managed care backlash in the United States? Disability and Health Journal, 13(3), 1–8. Web.
Duijmelinck, D., & van de Ven, W. (2016). What can Europe learn from the managed care backlash in the United States? Health Policy, 120(5), 509 518. Web.
Jones, A. (2018). States increasingly looking to managed care for long-term care services. Special Needs Answers. Web.
Pinkovskiy, M. L. (2020). The impact of the managed care backlash on health care spending. The RAND Journal of Economics, 51(1), 59–108. Web.